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NPI Code Detail

MEDICARE: LA FRONTER CENTER INC. DBA LA FRONTERA NEW MEXICO, INC.

MEDICARE: LA FRONTER CENTER INC. DBA LA FRONTERA NEW MEXICO, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/CenterNM

General Provider Information

NPI Number : 1659708576
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA FRONTER CENTER INC. DBA LA FRONTERA NEW MEXICO, INC.
Provider Business Mailing Address
First Line : 504 W 29TH ST
Second Line :
City : TUCSON
State : AZ
Zip : 85713-3353
Country : US
Telephone Number : 520-838-5600
Fax Number :
Provider Business Practice Location Address
First Line : 125 S MAIN ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1270
Country : US
Telephone Number : 575-647-2800
Fax Number :
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : DR. DANIEL J RANIERI
Credential : PHD
Telephone Number : 520-838-5600
Provider Enumeration Date : 10/09/2013
Last Update Date : 10/10/2013

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